Literatura académica sobre el tema "Zaner, Richard M. (1933-)"

This paper explores the intersection of applied phenomenology and clinical medical ethics, focusing on the work of Richard M. Zaner. The paper discusses how philosophers often find themselves in a precarious position in the clinical environment, where their principles, concepts, and theories are not directly applicable to clinical practice. The core argument revolves around the concept of human dignity, autonomy, and the “situated subject” in the context of illness. Zaner's approach to clinical ethics counseling suggests a shift from traditional ethical decision-making processes to a more engaged and dialogical method. He emphasizes understanding the patient's experience and context, considering the complexities of human interaction and communication in medical settings. The paper elaborates on Zaner's life and major works, his commitment to phenomenology, and his significant contributions to medical ethics. Zaner's methodology in clinical encounters and ethical consultations is examined, showcasing his unique approach to addressing ethical dilemmas in healthcare. Two cases are presented to illustrate Zaner's method in practice. The first case discusses the ethical dilemmas surrounding a critically ill newborn and the parents' role in decision-making. The second case involves the ethical considerations in the treatment of a terminally ill patient, highlighting the complexities of family dynamics and decision-making processes. In conclusion, the paper asserts that Zaner's achievements demonstrate the potential benefits of a phenomenological approach to clinical ethics. It suggests that this approach can bridge the gap between theory and practice in medical ethics, providing a more holistic and empathetic way of addressing ethical issues in healthcare.

The frequent use of metaphors in health care communication in general and clinical ethics cases in particular calls for a more mindful and competent use of figurative speech. Metaphors are powerful tools that enable different ways of thinking about complex issues in health care. However, depending on how and in which context they are used, they can also be harmful and undermine medical decision-making. Given this contingent nature of metaphors, this article discusses two approaches that suggest how medical health care professionals may systematically and imaginatively work with metaphors. The first approach is informed by a model developed by cognitive scientists George Lakoff and Mark Turner. The second approach is a close reading and thus a text-immanent, hermeneutical strategy. Using the double perspective of an ethics consultant and a researcher in literature studies, we take a case from Richard M Zaner in which a metaphor is central to the clinical-ethical problem. The article shows that the approaches, which focus on creativity and the intersections of form and content, may be helpful tools in clinical ethics, enabling a competent and mindful working with metaphors in complex cases as well as supporting the consultant’s thoughts processes.

This discussion was moderated by Vallerie V. McLaughlin, MD, Associate Professor of Medicine and Director, Pulmonary Hypertension Program, University of Michigan Health System, Ann Arbor, Michigan. Panel members included Richard N. Channick, MD, Associate Professor of Medicine, Pulmonary and Critical Care Division, University of California, San Diego Medical Center, San Diego, California; Ivan M. Robbins, MD, Director of the Pulmonary Hypertension Center, Vanderbilt University, Nashville, Tennessee; and Victor F. Tapson, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.

This discussion was moderated by Harrison (Hap) Farber, MD, Professor, Department of Medicine, Boston University School of Medicine, and Director, Pulmonary Hypertension Center, Boston Medical Center, Boston, Massachusetts. Panel members included Richard M. Silver, MD, Professor of Medicine and Pediatrics and Director of the Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Virginia D. Steen, MD, Proffessor of Medicine, Georgetown University, Washington, DC; and Charles Strange, MD, Professor of Pulmonary Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina.

In this discussion four experts shared insights on what might be considered the “gestalt” of diagnosing and monitoring pulmonary arterial hypertension. They ranged over a broad spectrum of issues that included thromboembolic pulmonary hypertension, exercise testing, hemodynamics, imaging studies, and response to therapy. The discussion was moderated by Vallerie V. McLaughlin, MD, Associate Professor of Medicine, Director, Pulmonary Hypertension Program, University of Michigan Health System, Ann Arbor, Michigan. The participants included Richard N. Channick, Associate Professor of Medicine, Pulmonary and Critical Care Division, University of California, San Diego Medical Center, San Diego, California; Ivan M. Robbins, MD, Director, Pulmonary Hypertension Center, Vanderbilt University, Nashville, Tennessee; and Victor F. Tapson, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.

This discussion was moderated by Michael McGoon, MD, Professor of Medicine and Consultant in the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. Participants included members of the Editorial Advisory Board of Advances in Pulmonary Hypertension: Victor F. Tapson, MD, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, and Editor-in-Chief of the journal; Richard N. Channick, MD, Associate Professor of Medicine, Pulmonary and Critical Care Division, University of California, San Diego Medical Center, San Diego, California; Vallerie V. McLaughlin, MD, Associate Professor of Medicine, Director, Pulmonary Hypertension Program, University of Michigan Health System, Ann Arbor, Michigan; Ronald J. Oudiz, MD, Associate Professor of Medicine, UCLA School of Medicine, and Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California; and Ivan M. Robbins, MD, Director, Pulmonary Hypertension Center, Vanderbilt University, Nashville, Tennessee.

Sharon Macdonald, Behind the Scenes at the Science Museum. By Jim Bennett 99Charles Mollan, William Davis and Brendan Finucane (eds.), Irish Innovators in Science and Technology. By Enda Leaney 100Pamela O. Long, Openness, Secrecy, Authorship: Technical Arts and the Culture of Knowledge from Antiquity to the Renaissance. By Catherine Eagleton, Karin Tybjerg and Koen Vermeir 101Antonio Clericuzio, Elements, Principles and Corpuscles: A Study of Atomism and Chemistry in the Seventeenth Century. By Christoph Lüthy 103Lisa Silverman, Tortured Subjects: Pain, Truth, and the Body in Early Modern France. By Sean M. Quinlan 105Trevor H. Levere and Gerard L'E. Turner, Discussing Chemistry and Steam: The Minutes of a Coffee House Philosophical Society 1780–1787. By William H Brock 106Claudine Cohen, The Fate of the Mammoth: Fossils, Myth, and History. By Bowdoin Van Riper 107David Elliston Allen, Naturalists and Society: The Culture of Natural History in Britain, 1700–1900. By Jim Endersby 108Roger Luckhurst, The Invention of Telepathy, 1870–1901. By Richard Noakes 110Benjamin H. Yandell, The Honors Class: Hilbert's Problems and Their Solvers. By I. Grattan-Guinness 112Emily Thompson, The Soundscape of Modernity: Architectural Acoustics and the Culture of Listening in America, 1900–1933. By Neil Pemberton 113

La lecture de la littérature scientifique nous permet d'établir que « les vécus et les représentations de la transplantation pulmonaire chez les adolescents atteints de mucoviscidose » sont méconnus. A l'heure où la réussite de cette intervention peut faire question (50% de taux de survie à cinq ans) et où des soignants ont pu constater le suicide d'une adolescente qui avait bénéficié d'une greffe, il nous a semblé intéressant de proposer une enquête d'une nature narrative et philosophique tout à fait nouvelle. Mais comment le philosophe peut-il sortir des comités d'éthique et des centres d'éthique clinique pour aller à la rencontre des patients ? Notre thèse cherche à distinguer cette approche philosophique des rares textes psychologiques, psychiatriques et psychanalytiques qui existent sur la question. Dans cette perspective, nous nous appuyons sur les travaux du philosophe américain Richard Zaner. A partir de ses expériences auprès de patients à Nashville, notre travail tente de montrer qu'il est possible au philosophe français d'utiliser son questionnement singulier, sa tendance à conceptualiser, et les ressources de sa discipline, pour livrer une analyse novatrice des vécus et des représentations de ces adolescents. En nous livrant, comme Zaner, à des « rencontres philosophiques » dont les discussions ne seraient pas guidées par des questionnaires directifs ou semi-directifs qui orientent souvent les réponses, nous pensons que nous pouvons fournir un travail scientifique et philosophique à partir des dires des patients. Notre travail s'inscrit dans ce que nous appelons aujourd'hui « l'éthique narrative ». De nature pluridisciplinaire, elle peut être pratiquée par des philosophes qui partent des récits de patients pour philosopher d'une manière nouvelle. Le philosophe a coutume de se situer sur le terrain du « principalisme » pour réfléchir sur la réalité médicale. Notre travail s'est efforcé de proposer, non pas une démarche de « haut en bas », mais de « bas en haut », de la réalité à l'analyse philosophique. Pour cela, nous sommes allés à la rencontre des patients pour éprouver (au sens de « faire l'épreuve ») notre hypothèse méthodologique. Nous avons tenté de mettre en oeuvre un travail collaboratif avec les soignants pour parvenir à des échanges fructueux avec les patients. A partir des rencontres avec les jeunes patients sur le thème de la transplantation, mais aussi sur un certain nombre de notions philosophiques, nous avons cherché à saisir les conceptions de l'existence de ces adolescents, ainsi que la place que pouvait y tenir la transplantation. Est-elle une rupture, une continuité ou une nouvelle « normativité » pour ces jeunes atteints de mucoviscidose ? La littérature classique sur la transplantation pose au centre des questions éthiques et existentielles, la question du sentiment de culpabilité et de la dette à l'égard du donneur, ainsi que celle de l'identité bouleversée du receveur, mais partir du vécu et des représentations des patients confirme t-il cela ? Le principe d'autonomie est-il aussi au centre des difficultés éthiques de cette pratique ? Le but de ce travail est de contribuer à ce que Pierre Le Coz appelait le « moment philosophique de la décision », ce moment critique et réflexif à distance d'une décision médicale. Notre approche propose ainsi une connaissance de l'individu qui doit nourrir les réflexions sur la décision médicale de transplantation. Nous ne pouvons figer une connaissance de l'individu, mais nous pouvons mettre en évidence la nécessité d'un aller et retour incessant allant de l'individuel au général, de la maladie vécue aux exigences de la pratique médicale. Revenant aux origines de la philosophie conçue d'abord comme une pratique orale, ce travail cherche à concilier l'usage d'une méthode qu'on pourrait qualifier de « phénoménologique », et des ressources conceptuelles et des questionnements qui débordent ce cadre de pensée
A survey of scientific publications allows us to establish that "experiences and perceptions of lung transplant among teenagers suffering from cystic fibrosis" are unexplored. At a time when this surgery appears questionable (its success rate reaching 50% 5 years after the graft) and doctors and paramedics witnessed the suicide of a teenage girl who had undergone surgery, it seemed interesting to us to suggest a brand new kind of narrative and philosophical investigation. But how can the philosopher venture out of ethics committees to meet the patients? Our PhD aims at distinguishing this philosophical approach from the scarce psychological, psychiatric and psychoanalytical texts that deal with the matter. With this objective in mind, we shall draw on the works of American philosopher Richard Zaner. Starting from his experience among patients in Nashville, our work attempts to show that it is possible for the French philosopher to use his or her singular questioning, tendency to conceptualize, and resources of his or her field to deliver an innovative analysis on the experiences and representations of these teenagers. By engaging in - like Zaner - philosophical meetings whose conversations would not be led by half-biased questionnaires channeling their answers, we think we are able to build a scientific and genuinely philosophical work from these patients accounts. Our work is in keeping with what we call today "narrative ethics". Multidisciplinary by nature, it can be applied by philosophers who build up from the patients stories to philosophize in a new way. The philosopher is used to relying on principalism to think about a medical reality. Our work has striven to offer an approach of actual philosophical analysis that was "bottom up" rather than "top down". To achieve this, we went to meet patients in order to put our methodological assumption to the test. We have tried to organize a team work with caregivers to obtain productive discussions with the patients. Drawing on our exchanges with young patients about the topic of transplant, but also on a number of philosophical notions, we have tried to understand how these teenagers perceived existence, and the place a transplant could hold in it. Is it a break, a continuity, or a new standard for these teenagers suffering from cystic fibrosis ? Standard publications about transplants hinge upon ethical and existential questions, the notion of guilt or debt towards the donor, but also the upset identity of the receiver. But does studying the experiences and representations of patients confirm this? Is the principle of autonomy still central to the ethical difficulties of this activity? The purpose of this work is to contribute to what Pierre Le Coz called "the philosophical time of decision", this critical and reflective moment surrounding a medical decision. Our approach thus suggests a knowledge of the individual that needs to encourage thinking about the medical decision of performing a transplant. We cannot consider this knowledge as definite, yet we can highlight the necessity of constantly moving back and forth between the individual and the general, between the illness and the demands of medical practice. By going back to the origins of philosophy - first conceived as an oral activity - this work seeks to reconcile the use of a method we could qualify as "phenomenological" with conceptual resources and questions that reach beyond this framework